title: Developing complex interventions: lessons learned from a pilot study examining strategy training in acute stroke rehabilitation.
abstract: OBJECTIVE
  To examine the feasibility of a strategy training clinical trial in a small group of adults with stroke-related cognitive impairments in inpatient rehabilitation, and to explore the impact of strategy training on disability.
  
  
  METHODS
  Non-randomized two-group intervention pilot study.
  
  
  METHODS
  Two inpatient rehabilitation units within an academic health centre.
  
  
  METHODS
  Individuals with a primary diagnosis of acute stroke, who were admitted to inpatient rehabilitation and demonstrated cognitive impairments were included. Individuals with severe aphasia; dementia; major depressive disorder, bipolar, or psychotic disorder; recent drug or alcohol abuse; and anticipated length of stay less than five days were excluded.
  
  
  METHODS
  Participants received strategy training or an attention control session in addition to usual rehabilitation care. Sessions in both groups were 30-40 minutes daily, five days per week, for the duration of inpatient rehabilitation.
  
  
  METHODS
  We assessed feasibility through participants' recruitment and retention; research intervention session number and duration; participants' comprehension and engagement; intervention fidelity; and participants' satisfaction. We assessed disability at study admission, inpatient rehabilitation discharge, 3 and 6 months using the Functional Independence Measure.
  
  
  RESULTS
  Participants in both groups (5 per group) received the assigned intervention (>92% planned sessions; >94% fidelity) and completed follow-up testing. Strategy training participants in this small sample demonstrated significantly less disability at six months (M (SE) = 117 (3)) than attention control participants (M(SE) = 96 (14); t 8 = 7.87, P = 0.02).
  
  
  CONCLUSIONS
  It is feasible and acceptable to administer both intervention protocols as an adjunct to acute inpatient rehabilitation, and strategy training shows promise for reducing disability.
authors.affiliation: 1Department of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Skidmore
authors.forename: Deirdre R
authors.initials: DR
authors.lastname: Dawson
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Whyte
authors.forename: Meryl A
authors.initials: MA
authors.lastname: Butters
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Emily S
authors.initials: ES
authors.lastname: Grattan
authors.forename: James T
authors.initials: JT
authors.lastname: Becker
authors.forename: Margo B
authors.initials: MB
authors.lastname: Holm
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001288:Attention; D003072:Cognition Disorders / Q000209:etiology / Q000534:rehabilitation*; D005240:Feasibility Studies; D005260:Female; D006040:Goals; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D020521:Stroke / Q000150:complications; D000071939:Stroke Rehabilitation
keywords: Rehabilitation interventions; cognitive impairment; strategy training; stroke